Date of Award

2019

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Pharmaceutical and Chemical Sciences

First Advisor

William A. Kehoe

First Committee Member

Michelle M. Amaral

Second Committee Member

Patrick N. Catania

Third Committee Member

Eric G. Boyce

Abstract

Pharmaceutical expenditures are an important part of the entire hospital operating budget, and inpatient pharmaceuticals denote one of the highest costs in hospital care. Predictions for medication budgets based on the types of patients have been largely undertaken in medical hospitals and not psychiatric facilities. According to several previous studies, gender, age, diagnosis, comorbidity and length of stay (LOS) affect the general inpatient treatment expenditures. However, whether or not the impact of these factors differs in psychiatric hospitals remains to be investigated. To that end, the current study examines medication costs for mental and behavioral health disorder as well as the primary chronic diseases commonly comorbid with mental and behavioral health disorders that suggest formulary management control might be helpful. Multiple regression models were developed to determine the leading drivers associated with the growing inpatient hospital medication costs among patients admitted to an acute psychiatric hospital. We also analyzed LOS using a Poisson model in order to determine whether it is a proxy for psychiatric inpatient medication costs.

Our finding selected 51 medications (14% of the 364 total medications consumed 90% of the total medication cost) under A category (AV, AE, and AN) and B category (BV, BE, and BN) in order to develop a medication list (MUC, medication under control) that suggested cost control measures based on cost and clinical criticality could be important. This study demonstrated that comorbidity, principal and secondary diagnoses, LOS, and MUC are associated with higher inpatient medication costs than other factors, including age, gender, insurance type, and month admitted. Our study also observed that the principal ICD-10-CM codes F10 (Alcohol related disorders) is associated with high inpatient medication cost. Secondary diagnosis related groups (DRGs) 203 (Bronchitis & asthma), 192 (Chronic obstructive pulmonary disease, COPD), 201 (pneumothorax), 639 (Diabetes), 642 (Inborn and other disorders of metabolism), 645 (Endocrine disorders), 641 (Nutritional & miscellaneous metabolic disorders), 690 (Kidney & urinary tract infections), 675 (Other kidney & urinary tract procedures), 699 (Other kidney & urinary tract diagnoses), and 700 (Other kidney and urinary tract diagnoses), 305 (Hypertension), 310 (Cardiac arrhythmia & conduction disorders), 303 (Atherosclerosis), 293 (Heart failure & shock), and 316 (Other circulatory system diagnoses) were found to be associated with higher inpatient medication costs. In addition, LOS can be used as an indicator (proxy) for inpatient medication cost when patients present with a secondary DRG 639 (diabetes) and 690 (kidney & urinary tract infections) in an acute psychiatric hospital.

Viewed collectively, this study would enable executives of acute psychiatric hospitals to identify the most important factors that are associated with high inpatient medication costs, thereby assisting in the development of the hospital pharmaceutical budget using a novel and scientific approach.

Pages

122

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